Important information about utilization management
You can request a free copy of our UM criteria from our Medical Management department. Within seven calendar days of the date of denial, providers can discuss a UM denial decision with a physician reviewer by calling us toll free at the numbers listed below.
We are staffed with clinical professionals who coordinate our members’ care and are available 24/7 to accept precertification requests. Secured voicemail is available during off-business hours. A clinical professional will return your call within the next business day. Our staff will identify themselves by name, title and with Anthem Blue Cross and Blue Shield Medicaid when initiating or returning calls regarding UM issues.
Our medical policies and UM criteria can be found online at https://mediproviders.anthem.com/ky/pages/other-resources.aspx.
You can submit precertification requests by:
- Calling us at 1-855-661-2028.
- Faxing to 1-800-964-3637.
- Submitting online at https://www.availity.com
Have questions about utilization decisions or the UM process?
Call our Clinical team at 1-855-661-2028 Monday through Friday from 7 a.m. to 7 p.m.
June 2019 Anthem Provider Newsletter - Kentucky